MyPlate Parent/Student REV

Generic Clearance to Conduct Formative Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20.docx Other-Attachment B - Parent Letter_R
Attachment D1 - Pre-Test Survey Instrument for Students_March13r.doc Other-Attachment D1 - Pre-Test Surve
Attachment D2 - Post-Test Survey Instrument for Students_March13r.doc Other-Attachment D2 - Post-Test Surv
Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r.docx Other-Attachment E - Moderator's Gui
MyPlate OMB Proposal_march22.docx MyPlate Generic Clearance Memo IC Document
MyPlateTakehome-FINAL-3-7-12.pdf MyPlate Brochure English IC Document
MyPlateTakehomeSPANv2-Final Spanish-3-7-12.pdf MyPlate Brochure Spanish IC Document

Information Collection (IC) Details

IC Title:	MyPlate Parent/Student REV	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20	Attachment B - Parent Letter_Response Form_Consent Form for Parent_Consent Form for Student_ENGLISH_SpanishApril20.docx	No	Paper Only
Other-Attachment D1 - Pre-Test Survey Instrument for Students_March13r	Attachment D1 - Pre-Test Survey Instrument for Students_March13r.doc	No	Paper Only
Other-Attachment D2 - Post-Test Survey Instrument for Students_March13r	Attachment D2 - Post-Test Survey Instrument for Students_March13r.doc	No	Paper Only
Other-Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r	Attachment E - Moderator's Guide for Parent Focus Group_MyPlate at Home Handout_ENGLISHMarch_13r.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-8, FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	98	98
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
MyPlate Generic Clearance Memo	MyPlate OMB Proposal_march22.docx	04/23/2012
MyPlate Brochure English	MyPlateTakehome-FINAL-3-7-12.pdf	04/23/2012
MyPlate Brochure Spanish	MyPlateTakehomeSPANv2-Final Spanish-3-7-12.pdf	04/23/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.